Building Sustainable Financing Structures for Population Health Insights from Non-Health Sectors: Proceedings of a Workshop (2018) / Chapter Skim
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5 Realigning Resources for Population Health: Small Group Conversations
5 Realigning Resources for Population Health: Small Group Conversations
Pages 47-60
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From page 47... ...
The examples discussed showed how investment and reinvestment can lead to very different sets of results for offenders and communities. Similarly, in the energy sector, Milstein added, the petro-industrial complex causes some harm, and efforts are under way to transition to greener, more efficient energy.
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From page 48... ...
How, with the assistance of financing experts and by taking lessons from other industries that have restructured to achieve similar co-benefits, can greater value and efficiencies be gained through focused innovations that improve population health? Milstein acknowledged that the presentations only scratched the surface of how justice reinvestment actually works financially and only modestly explored the nuances of inclusive financing in the energy arena.
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From page 49... ...
Hospital community benefit • Community Health Improvement • Community Building 4. Health care payment reform • Value-Based Contracts (and MACRA)
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From page 50... ...
Milstein highlighted multi-philanthropic initiatives, such as the Convergence Partnership and the BUILD Health Challenge, which he said are demonstrating pioneering ways of pooling philanthropic money for much longer-term and more profound types of investments.2 In-Kind or Barter Agreements Another financing structure is in-kind or barter agreements. These can sometimes be more durable than short-term grants, as people see themselves as being in business with one another.
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From page 51... ...
Milstein mentioned the Public Health Institute in California, which has a program that invests legal settlement funds to improve public health and seeks public discourse about how the funds should be invested.3 Gain Sharing Agreements The case examples of justice reinvestment and clean energy funding that were discussed at the workshop were concentrated on a class of financing structures that are essentially about gain sharing, Milstein explained. These agreements recognize co-benefits and are predicated on the idea that investments can deliver yield and that yield, in turn, can be strategically applied as the next new investment in something else.
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From page 52... ...
He explained that the first-generation wellness trusts were funded by taxes on health care expenditures; however, the new generation of wellness funds associated with accountable communities for health are nongovernmental. Community Wealth Building One important aspect of community wealth building recognizes that institutions have a more significant impact on the economic life of their communities than just the services they provide.
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From page 53... ...
The solutions that lead to a more interdependent health economy are often those where the parties see the potential to generate greater value together than alone, he said. Isham referred participants to the Institute of Medicine report For the Public's Health: Investing in a Healthier Future, which considered mechanisms for funding governmental public health (IOM, 2012)
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From page 54... ...
If their actions combined to deliver an ultimate reduction in cost, it is a fair question to ask why they would not be included in the conversations about how to best to use the savings. CHARGE TO THE BREAKOUT GROUPS Following the overview of financing structures and examples by Milstein, participants broke into three groups to discuss what they felt were the key takeaway messages from the workshop presentations to this point.
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From page 55... ...
As discussed in the presentations, actions taken in the energy sector can benefit other sectors, including health. There are potential opportunities for the public health sector to support other sectors in their work, whether or not those efforts are explicitly viewed as health interventions.
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From page 56... ...
The group came up with two additional lenses to apply when considering financing structures. One was to consider both operating expenses and capital expenses, acknowledging that public health has little capital expense.
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From page 57... ...
Cross-Sector Agreements for Mutual Regulation Impact Assessments Kelly reported two pathways to the solutions discussed during her breakout session. The first was inspired by the use of social costs in the energy case examples and by the justice reinvestment model.
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From page 58... ...
For example, hospital systems think of population health relative to their patient populations, while those in the public health sector think of population health relative to the broader population. Isham asked whether these types of approaches could lead to a reciprocal of health-in-all-policies such that whatever the population health sector does, it must consider energy in all of its policies, criminal justice in all of its policies, and so forth.
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From page 59... ...
Milstein also drew the audience's attention to the Trust for America's Health report Blueprint for a Healthier America, which was released the morning of the workshop.4 The report contains examples of multi-sector local health improvement collaboratives and identifies and recommends investments that could improve health. The Role of Business Organizations Milstein reported that his group discussed the role of businesses and economic development corporations in financing population health.
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From page 60... ...
60 BUILDING SUSTAINABLE FINANCING STRUCTURES FOR POPULATION HEALTH Establish a For-Profit Company with Profits Directed Toward Public Health Several participants in LaVeist's group also suggested the notion of establishing a for-profit company with profits directed into equity-based, evidence-based public health interventions. This could be a sustainable model for supporting public health interventions that would improve health outcomes and create jobs.
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